Direct Access to PTs Now a Reality in Oklahoma

Oklahomans now have direct access to evaluation and treatment by physical therapists (PTs). On May 23, Oklahoma Gov Mary Fallin signed HB 1020, which allows patients to be evaluated and treated by a PT for 30 days without a referral from a physician or other provider. Previously, state law required a physician referral for any kind of treatment, though PTs were allowed to provide an evaluation without a referral. The new law takes effect November 1, 2014.

"Ensuring patient access is a cornerstone of APTA's vision and mission," said APTA President Paul A. Rockar Jr, PT, DPT, MS, in a news release. "I want to thank Rep Arthur Hulbert, PT, DPT, for authoring this bill, and Rep Sean Roberts, PT, for coauthoring. As physical therapists, Rep Hulbert and Rep Roberts truly understand how important this legislation is and the positive impact it will have on individuals who need the services of physical therapists."

The bill was promoted by the Oklahoma Chapter of APTA (OPTA). OPTA President Debra Christian, PT, DPT, said, "This is an historic time for the Oklahoma Chapter and the culmination of many years of work by numerous individuals. I want to thank the OPTA Board of Directors for their commitment to this effort, as well as our membership who stepped up in a big way over the past couple of months." Christian also acknowledged the leadership of Jeffrey Jankowski, PT, immediate past president of OPTA.

Brandon Trachman, PT, MPT, OCS, OPTA legislative chair, added, "HB 1020 is an enormous victory for Oklahomans, who will now be able to take a more active role in their own health care and choose safe and effective treatment directly from physical therapists. The passage of HB 1020 would have never been possible without the diligent and tireless efforts of Reps Hulbert and Roberts, as well as Sen Kim David, who authored a version of this bill in the Senate."

APTA provided a direct access grant to the Oklahoma Chapter, as well as additional financial support for the chapter's lobby day at the state capitol.

The success in Oklahoma means that 49 states and the District of Columbia now allow some level of treatment by a PT without referral. Direct access legislation is pending in Michigan, the final state with no form of direct access to treatment by PTs. Michigan SB 690 recently received a unanimous vote in the Senate and now awaits action in the state House of Representatives.

Comments

You mention that Michigan is the last state without direct access; you forget Texas has eval only access. How about hoping out here!

Posted by James Lewis
on 6/6/2014 3:44 PM

Great News!
Unfortunately, the benefits of this direct access to PT services really does not do anything more for PT providers then a allow a free screening to our patients without the doctors acknowledgement. In Massachusetts, we are bound by the payers to provide a pre authorization and most often a script or referral from the PCP. Medicare alone states the PCP has to date and sign our evaluations in 30 days or the entire claim can be "technically" denied. Therefore, a patient my come directly to our offices, get the services they need , and then walk off and leave us with a denied bill if the PCP does not sign off on the evaluation or the referral is not provided to the payer. Yes, this is direct access to us, but at our expense! I understand, that some sort of political organization has to be achieved to reach our goals , but to me this seems backwards and now almost useless for the private practice groups. If anyone can further explain how this helps our profession from a business side of things an explanation would be greatly appreciated.
By the way, Direct Access may further be hurt in the near future by the power allowed by ACOs. I feel like we are missing the target with this. Does anyone else feel this way ?

Posted by mark karoul
on 6/6/2014 10:20 PM

This victory now puts PT in the hands of the consumer and demands new expectations from the PTs to educate the consumer. Patients and therapists have historically been too timid to demand what they want from insurance companies and PCPs.
Our patients call their PCP after our initial examination and tell their physician to sign off on it-- not ASK-- because the pt "finally found the place I want to be seen to fix my back problem." We lay it out for the pt as the procedure to follow in order to get treated by us. Literally works 98% of the time. When the PCP won't sign, we give the pt "PT friendly" physician names so they can make an appointment there and get it signed. The consumer financially supports this cycle .
Pts also are required to sign a note stating that if the insurance company denies the claim, the pt is responsible for the balance. Your billing team is the enforcer. Once the heat is on the pt, know that they become their own best advocate to achieve reimbursement and make changes to insurance policies. We coach them through verbiage like, "this 4 weeks of treatment just saved you thousands of dollars in unnecessary surgery and diagnostic testing-- this claim should be paid." Etc. Again, coming from the consumer is the strongest form of advocacy-- look at what the chiropractic consumers did in the eighties. Literally changed insurance carriers to accept chiro as legitimate treatment.
We can, too. Help our pts advocate for what they want!

Posted by April Oury
on 6/7/2014 1:32 AM

I understand the points made by both Mark and April and appreciate the information. Unfortunately we already receive a great deal of denials due to lack of pre-auth even with an MD referral. Does anyone in a direct access state have any advice on how to work around this? Are insurance companies denying due to lack of pre-auth, no MD referral, or both? If it is lack of MD approval is there a work around? I understand April's point about having a pt sign a pt. responsibility form. My main concern is where the insurance companies stand re: direct access as we move forward.
Thanks for any input!

Posted by Chris Easton
on 10/20/2014 10:28 AM

I have taken a bad fall which resulted in broken ankle. I will contact you when pt is needed.